The Development and Evaluation of an Online Healthcare Toolkit for Autistic Adults and their Primary Care Providers

Christina Nicolaidis, Dora Raymaker, Katherine E McDonald, Steven Kapp, Michael Weiner, Elesia Ashkenazy, Martha Gerrity, Clarissa Kripke, Laura Platt, Amelia Baggs

Research output: Contribution to journalArticle

12 Scopus citations


Background: The healthcare system is ill-equipped to meet the needs of adults on the autism spectrum. Objective: Our goal was to use a community-based participatory research (CBPR) approach to develop and evaluate tools to facilitate the primary healthcare of autistic adults. Design: Toolkit development included cognitive interviewing and test–retest reliability studies. Evaluation consisted of a mixed-methods, single-arm pre/post-intervention comparison. Participants: A total of 259 autistic adults and 51 primary care providers (PCPs) residing in the United States. Interventions: The AASPIRE Healthcare toolkit includes the Autism Healthcare Accommodations Tool (AHAT)—a tool that allows patients to create a personalized accommodations report for their PCP—and general healthcare- and autism-related information, worksheets, checklists, and resources for patients and healthcare providers. Main Measures: Satisfaction with patient–provider communication, healthcare self-efficacy, barriers to healthcare, and satisfaction with the toolkit’s usability and utility; responses to open-ended questions. Key Results: Preliminary testing of the AHAT demonstrated strong content validity and adequate test–retest stability. Almost all patient participants (>94 %) felt that the AHAT and the toolkit were easy to use, important, and useful. In pre/post-intervention comparisons, the mean number of barriers decreased (from 4.07 to 2.82, p < 0.0001), healthcare self-efficacy increased (from 37.9 to 39.4, p = 0.02), and satisfaction with PCP communication improved (from 30.9 to 32.6, p = 0.03). Patients stated that the toolkit helped clarify their needs, enabled them to self-advocate and prepare for visits more effectively, and positively influenced provider behavior. Most of the PCPs surveyed read the AHAT (97 %), rated it as moderately or very useful (82 %), and would recommend it to other patients (87 %). Conclusions: The CBPR process resulted in a reliable healthcare accommodation tool and a highly accessible healthcare toolkit. Patients and providers indicated that the tools positively impacted healthcare interactions. The toolkit has the potential to reduce barriers to healthcare and improve healthcare self-efficacy and patient–provider communication.

Original languageEnglish (US)
Pages (from-to)1180-1189
Number of pages10
JournalJournal of General Internal Medicine
Issue number10
StatePublished - Oct 1 2016



  • adults
  • autism
  • community-based participatory research
  • healthcare interactions
  • primary care

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Nicolaidis, C., Raymaker, D., McDonald, K. E., Kapp, S., Weiner, M., Ashkenazy, E., Gerrity, M., Kripke, C., Platt, L., & Baggs, A. (2016). The Development and Evaluation of an Online Healthcare Toolkit for Autistic Adults and their Primary Care Providers. Journal of General Internal Medicine, 31(10), 1180-1189.